Similarities and differences between continuous sedation until death and euthanasia – professional caregivers’ attitudes and experiences: A focus group study

Anquinet, Livia; Raus, Kasper; Sterckx, Sigrid; Smets, Tinne; Deliens, Luc; Rietjens, Judith Anna Cathari

doi:10.1177/0269216312462272

Cited by 53 publications

(47 citation statements)

References 16 publications

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“…The authors explain that this practice can only be performed when the patient has a very limited life expectancy and that it does not aim at the death of the patient 46. This definition lumps together continuous sedation and continuous sedation until death .…”

Section: Introductionmentioning

confidence: 99%

Euthanasia and palliative sedation in Belgium

Cohen‐Almagor

Ely

2018

BMJ Support Palliat Care

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The aim of this article is to use data from Belgium to analyse distinctions between palliative sedation and euthanasia. There is a need to reduce confusion and improve communication related to patient management at the end of life specifically regarding the rapidly expanding area of patient care that incorporates a spectrum of nuanced yet overlapping terms such as palliative care, sedation, palliative sedation, continued sedation, continued sedation until death, terminal sedation, voluntary euthanasia and involuntary euthanasia. Some physicians and nurses mistakenly think that relieving suffering at the end of life by heavily sedating patients is a form of euthanasia, when indeed it is merely responding to the ordinary and proportionate needs of the patient. Concerns are raised about abuse in the form of deliberate involuntary euthanasia, obfuscation and disregard for the processes sustaining the management of refractory suffering at the end of life. Some suggestions designed to improve patient management and prevent potential abuse are offered.

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Section: Introductionmentioning

confidence: 99%

Euthanasia and palliative sedation in Belgium

Cohen‐Almagor

Ely

2018

BMJ Support Palliat Care

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“…Hinzu kommen noch wichtige technische Differenzierungen wie die Unterscheidung zwischen "intermittierender" versus "kontinuierlicher" Sedierung. Hier wird -in Analogie zur klinischen Praxis -in der wissenschaftlichen Literatur deutlich, dass unter "Palliativer Sedierung" ein Spektrum unterschiedlicher Vorgehensweisen von "Sedierung" im Kontext der Palliativversorgung verstanden wird [5,22,24,43,56]. Daher scheint es erforderlich, in Bezug auf eine konkrete klinische palliative Situation, in der eine "Sedierung" erörtert wird, jeweils zu beschreiben, welche Maßnahme in welcher Intention und mit welcher Durchführungspraxis konkret gemeint ist, da ein distinktes (und einheitlich definiertes) Verständnis des Begriffs "Sedierung" im palliativmedizinischen Kontext und auch eine einheitliche ethische Bewertung der verschiedenen Durchführungspraktiken nicht existiert [1,26,33,43,50,51,57].…”

Section: Die Begriffsverwirrungunclassified

“…Fälle von Palliativer Sedierung als Euthanasie zu melden [59]. • In einer belgischen, qualitativen Studie gaben ein Teil der in Focusgruppen befragten Ärzte an, dass die Unterscheidung zwischen DCSD und Euthanasie verwischt sei, vor allem dann, wenn die sedierende Medikation überproportional gesteigert würde oder wenn die Sedierung für Patienten in früheren Erkrankungsstadien eingesetzt würde [5].…”

Section: Problem 6: Die Nähe Und Der üBergang Zu (Klinisch Ethisch Uunclassified

Was ist das Problematische an der Palliativen Sedierung? – eine Übersicht

2014

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Zusammenfassung Die Palliative Sedierung als therapeutische Handlungsoption in anderweitig refraktären Behandlungssituationen wird in der Öffentlichkeit und in Fachkreisen in ihrer klinischen Wertigkeit grundsätzlich akzeptiert und weitgehend positiv konnotiert. Im Widerspruch dazu fallen sowohl die Quantität der empirischen Forschung als auch die Intensität der ethischen und klinischen Diskussion ins Auge, mit der konzeptuelle als auch durchführungsbezogene Aspekte der Palliativen Sedierung beschrieben und kontrovers erörtert werden. Anstatt eines distinkten Behandlungskonzeptes stellt sich hier eher ein komplexes Spektrum verschiedener (und ggf. ethisch verschieden zu bewertender) Vorgehensweisen dar. Die folgende Übersichtsarbeit fasst anhand der aktuellen Literatur zusammen, welche Aspekte im Kontext der Palliativen Sedierung als problematisch bewertet werden.Schlüsselwörter Palliative Sedierung · Symptomkontrolle · Unerträgliches Leid · Tiefe kontinuierliche Sedierung · Euthanasie What is problematic with palliative sedation?: a review Abstract Definition of the problem Palliative sedation as a therapeutic option in otherwise refractory clinical situations has been broadly accepted and appreciated by general society and by health care professionals. Arguments However, intense empirical research activities have been undertaken and there is an ongoing controversial ethical and clinical debate on conceptual and procedural aspects of palliative sedation. Conclusion This review discusses the current literature and the aspects on palliative sedation that are considered problematic, 2 B. Alt-Epping et al. 3and finds a complex spectrum of different modes of conduct (subject to moral reasoning and different moral judgments), rather than a distinct conceptual entity.

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“…CPS does not shorten the patient's life and should not be confused with euthanasia that is instead, the administration of drugs, under explicit request of a patient, at the aim to the intentional ending of his life. 6,10,11,[17][18][19][20][21][22][23][24][25][26][27] During CPS it is important to monitor the sedation, evaluating the patient's clinical condition, consciousness and refractory symptom control in order to establish the need to adjust the drug dosage. 2,11,28,29 A validation scale is recommended for this purpose.…”

Section: Introductionmentioning

confidence: 99%

Multi-Professional Medical Record on Continuous Palliative Sedation in an Inpatient Hospice: A Feasibility Pilot Study

Pallotti¹,

Giovannini²,

Possenti³

et al. 2017

HPMIJ

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Continuous palliative sedation (CPS) is a treatment aimed to relieve refractory symptom in end-of-life patient. The decision to start it involves palliative care unit, patient and caregiver (CG). The objective of this study was to evaluate the feasibility of an instrument to monitor CPS in end-of-life patients. This prospective study was conducted for one year at Bentivoglio Hospice (Bologna, Italy). The multiprofessional medical record (MPMR) is compiled every time a patient begins the CPS. It was composed by four categories of questions on the patient, CG, clinical and pharmacological aspects. MPMR were compiled for 91(16.9%) patients among the 538 patients who died during the study period. Eighty-nine patients had cancer while two had non-neoplastic disease. The most common refractory symptom was dyspnea (58.2%) followed by delirium (36.3%). Before the onset of the refractory symptom, we openly discussed sedation with 13 patients, while direct patient's agreement to start palliative sedation was possible in 16 cases only. The hospice team evaluated the experience of CPS for CGs. Midazolam was the sedative drug preferred for induction and maintenance of CPS and 64.8% of patients did not need dosage increases during the maintenance period. A careful evaluation of CPS is important in clinical and pharmacological aspects and in the decision-making process shared by the care team, patient and CG. The MPMR is easy to compile, improves evaluation and follow-up of CPS. It also promotes standard team language and allows a comparison with other settings. of the case). We noticed that there is a lack of data in the clinical diary about CPS. For example the steps for the diagnosis of the refractory symptom weren't recorded, the specific treatments administered to control the symptom before the beginning of the CPS, were not always reported in the clinical diary but always in pharmacology report. The RASS scale and the discussion about CPS between palliative care team and the patient were never reported. At the aim of filling this lack we proposed and verified a tool that permitted to report the decision making process of the CPS, simple to use. Keywords MethodsThis is a feasibility pilot study conducted for 12 months at Bentivoglio Hospice (Bologna, Italy). During the study period, every patient admitted to our Hospice was evaluated for enrollment. Inclusion criteria were as follows: a) age>18years, b) inpatient hospice, c) affected by neoplastic or not neoplastic disease, d) onset of a refractory symptom. Exclusion criteria were as follows: a) age<18 years, b) a challenging symptom. We develop a multi-professional medical record (MPMR) focusing on the multiple aspects of the CPS: the patients, the caregivers' experience, and the pharmacological aspects of the sedation process as tool for the assessment and follow up of CPS. The MPMR is an ad hoc clinical chart within medical record for monitoring the different aspects of CPS in end-of-life patients with neoplastic or other diseases admitted to the Hospice, who s...

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Similarities and differences between continuous sedation until death and euthanasia – professional caregivers’ attitudes and experiences: A focus group study

Cited by 53 publications

References 16 publications

Euthanasia and palliative sedation in Belgium

Euthanasia and palliative sedation in Belgium

Was ist das Problematische an der Palliativen Sedierung? – eine Übersicht

Multi-Professional Medical Record on Continuous Palliative Sedation in an Inpatient Hospice: A Feasibility Pilot Study

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